According to the report, requiring or coercing individuals to undergo sterilizing procedures violates the fundamental human rights to health, information, privacy, children, family, and freedom from discrimination. These surgical requirements impact transgender individuals who are seeking legal recognition for their gender as well as intersex individuals, who are often involuntarily subjected to “sex-normalizing” procedures as infants or children, which can compromise their reproductive ability. The report notes that these required surgeries “run counter to respect for bodily integrity, self-determination, and human dignity, and can cause and perpetuate discrimination against transgender and intersex person.”

“Discrimination on the basis of gender identity,” the report offers, has been recognized as a “human rights violation.” It recommends that laws be revised to “remove any requirements for compulsory sterilization of transgender persons.”

Though “sterilization” is not a word often used in the U.S. in reference to transgender people, it remains a requirement in many states for trans individuals to obtain legal documents reflecting their gender, such as birth certificates. Over 30 states require either by law or by established practice that transgender individuals complete gender confirmation surgery before they are eligible to change the gender marker on their birth certificates. Individuals are bound by the laws of the state in which they were born, and some states — like Tennessee — provide no means for amending birth certificates under any circumstance. Only a slim few allow for gender marker changes based on non-surgical transitions supported by hormone treatment and therapy.

Many transgender people never undergo surgical procedures as part of their transition. This could be because they cannot afford it, because they do not wish to sacrifice their reproductive ability, or because they simply do not feel such measures are required for them to realize their authentic gender identity. According to the National Transgender Discrimination Survey, only between a fifth and a quarter of respondents had actually undergone such procedures, though over half of respondents hoped to someday. The survey also found that while some individuals successfully changed their driver’s license or birth certificate gender markers without surgery, those who had undergone some form of surgery were more likely to be allowed, but many were denied even if they had.

According to its 2010 guidelines, the World Health Organization still diagnoses transgender identities as a mental disorder. Those guidelines are due to be updated in 2015, and trans advocates have been calling on the WHO to change its classification, just as the American Psychiatric Association did in 2012.